A tour of the state foren­sic med­i­cal cen­ter il­lu­mi­nated the opi­oid epi­demic

The Washington Post Sunday - - LOCAL OPINIONS - The writer, a Demo­crat, rep­re­sents the 14th District in the Mary­land House, where she serves on the Ju­di­ciary Com­mit­tee.

With some ap­pre­hen­sion, I agreed to join col­leagues from the Mary­land Gen­eral As­sem­bly on a tour of the Mary­land Of­fice of the Chief Med­i­cal Ex­am­iner to learn about foren­sic in­ves­ti­ga­tions, ev­i­dence col­lec­tion and cause and man­ner of death, is­sues rel­e­vant to top­ics de­bated in the House Ju­di­ciary Com­mit­tee. They also are rel­e­vant to the state’s opi­oid epi­demic. Key to our tour was the au­topsy room, where about 5,000 au­top­sies are con­ducted each year. Af­ter cover­ing our street clothes, we en­tered one of the two re­frig­er­ated au­topsy rooms. On that morn­ing, the room had fewer than a dozen un­clothed corpses, each on a sep­a­rate stain­less-steel op­er­at­ing ta­ble, await­ing dis­sec­tion.

I had been cau­tioned that I would see dead peo­ple but was as­sured that the han­dling of the bod­ies would be pro­fes­sional, clin­i­cal and def­er­en­tial. Still, prox­im­ity to dead bod­ies was unsettling to me, so in­stead of avert­ing my eyes and cover­ing my nose to avoid the un­fa­mil­iar smell, I moved to the ob­ser­va­tion deck to view the ex­ams.

Deaths from over­doses are not the only ca­su­al­ties of the drug epi­demic. The in­deli­ble im­age of a young male body with mul­ti­ple stab wounds re­minded me that our state’s drug-ad­dic­tion cri­sis has deadly and wide-rang­ing ef­fects.

The foren­sic med­i­cal cen­ter is a high-tech fa­cil­ity open 24 hours a day, 365 days a year and staffed with more than 80 full-time em­ploy­ees and 120 part-time staff, in­clud­ing in­ves­ti­ga­tors and pathol­o­gists who per­form foren­sic in­ves­ti­ga­tions, the pri­mary tool to de­ter­mine cause and man­ner of death. This state-of-theart fa­cil­ity is rem­i­nis­cent of a uni­ver­sity med­i­cal fa­cil­ity, con­ducive to sci­en­tific in­quiry. OCME staff are specif­i­cally trained to rec­og­nize pat­terns of in­jury, col­lect ev­i­dence and in­ves­ti­gate cir­cum­stances sur­round­ing deaths. The OCME is the only place that in­ves­ti­gates re­ferred cases (about one-third of all deaths) brought from any­where in Mary­land.

The OCME holds train­ing pro­grams for foren­sic in­ves­ti­ga­tors and law en­force­ment. The fa­cil­ity has a re­al­is­tic house in which train­ers stage crime scenes for stu­dents to hone their skills. At a death scene, af­ter first-re­spon­ders ar­rive, foren­sic in­ves­ti­ga­tors are called to record and re­port ob­ser­va­tions be­fore the body is trans­ferred to the OCME. Our visit to an ex­hibit room of dio­ra­mas that re-cre­ate death scenes il­lu­mi­nated the dif­fi­culty in de­ter­min­ing cause of death. By Mary­land law, the OCME de­ter­mines the cause of death with a rea­son­able de­gree of cer­tainty for deaths from in­jury, homi­cide, sui­cide or un­usual or sus­pi­cious cir­cum­stances in which a per­son is not un­der a physi­cian’s care.

The OCME iden­ti­fies mor­tal­ity trends. A grow­ing mor­tal­ity trend in Mary­land is opi­oid over­dose. But over­dose isn’t the only cause of death as­so­ci­ated with ad­dic­tion. Ac­cord­ing to the Na­tional In­sti­tute on Drug Abuse, drug abuse leads to health and pub­lic safety risks in­clud­ing ad­dic­tion-re­lated crimes, drugged driv­ing, in­fec­tious dis­ease, low-birth-weight ba­bies and in­fant deaths.

Last year, Mary­land had a 66 per­cent surge in dru­gand al­co­hol-re­lated in­tox­i­ca­tion deaths. Many of th­ese deaths were re­lated to syn­thetic and pre­scrip­tion opi­oid-re­lated over­doses, and they hap­pen across race, age and eco­nomic lev­els. Un­der­stand­ably, Gov. Larry Hogan (R) de­clared a state of emer­gency.

Al­co­hol- and drug-re­lated ad­dic­tion can be treated as a pub­lic-health or a crim­i­nal-jus­tice is­sue. The lat­ter tac­tic, the war on drugs, has been tried in a failed, 40-year cam­paign in­tended to end the im­port, man­u­fac­ture, sale and use of il­le­gal drugs. It has done lit­tle to cur­tail drug ad­dic­tion, but it has led to greater drug sup­ply, mass in­car­cer­a­tion and in­creased drug vi­o­lence. Be­cause of the war on drugs, many peo­ple view ad­dic­tion as im­moral or a char­ac­ter de­fect that re­quires pun­ish­ment or in­car­cer­a­tion.

Mary­land is among the states al­lo­cat­ing bud­get dol­lars to treat­ing drug ad­dic­tion as a chronic dis­ease and cre­at­ing poli­cies to help peo­ple stop drug use, stay drug-free or de­lay the start of drug use.

In­deed, un­der­stand­ing the root cause deaths in our state can ef­fect bet­ter pub­lic pol­icy. I know Mary­lan­ders will be best served with an evolved drug pol­icy, fo­cused on ad­dic­tion treat­ment, which will lead to fewer corpses at the shiny foren­sic med­i­cal cen­ter in Bal­ti­more.

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